Rosario Teresa Saylo

Title: Comparative evaluation of early warning and severity scores (NEWS2, MEWS, SAPS II, SOFA, qSOFA and Modified APACHE II) in predicting septic shock, mortality and organ failure among elderly sepsis patients: A retrospective cohort study

Abstract

This retrospective cohort study evaluated the predictive performance of six early warning and severity scoring systems—NEWS2, MEWS, SAPS II, SOFA, qSOFA, and modified APACHE II—for early identification of septic shock among elderly patients (≥65 years) presenting with sepsis to the Emergency Department of a tertiary hospital from January to December 2024. Seventy-four patients were included, of whom 38% developed septic shock. Diagnostic accuracy analyses demonstrated uniformly poor discrimination across all scores, with area under the ROC curves ranging from 0.46 to 0.56, indicating failure to reliably distinguish patients who would progress to shock. qSOFA exhibited the highest sensitivity (75%) but low specificity (34.8%), while SAPS II showed the highest specificity (54.4%). Secondary analyses revealed similarly limited predictive value for in-hospital mortality, organ failure, and need for mechanical ventilation, with only SAPS II and MEWS achieving fair performance for select outcomes. Patients who developed septic shock experienced significantly higher rates of ICU admission, respiratory and renal failure, mechanical ventilation use, and mortality. Findings highlight the limited utility of commonly used scoring systems in early risk stratification of elderly septic patients and underscore the need for age-specific or multimodal predictive tools.

The audience take away from presentation:

1.Commonly used sepsis scoring systems (NEWS2, MEWS, SAPS II, SOFA, qSOFA, modified APACHE II) perform poorly in predicting early septic shock in elderly ED patients, with AUCs consistently below 0.60.

2.No single score provides an acceptable balance of sensitivity and specificity for early risk stratification in older adults with sepsis.

3.Elderly patients who progress to septic shock have markedly worse outcomes, including higher ICU admission rates, organ failure, need for mechanical ventilation, and mortality.

4.Reliance on standard early warning scores alone may delay recognition of high-risk elderly patients.

5.There is a clear need for age-specific or multimodal approaches to sepsis risk assessment in older adults.